The toxic profile of gemcitabine was major in hematopoietic system especially neutropenia and thrombocytopenia (4). In NPC treatment, gemcitabine had been the focus of several reports, with interesting OR rates in the range of 23—48% and median progression-free survival (PFS) of between 3.6 and 5.1 months (5). In combination chemotherapy with cisplatin, the OR rate 42.7 to 73% had been reported and median PFS were 5.6 to 10.6 months (6). In combined with oxaliplatin, the OR rate was 56.1 % and median PFS was 9 months (6). In combined with vinorelbine, OR rate 36 to 37.7% had been reported and median PFS were 5.2 to 5.6 months. In multiple drugs combination with carboplatin, paclitaxel, 5-Fluoro-Uracil/LeucoVorin, high OR rate with 86% had been reported but with median PFS of 8 months (6). Still these trials were done in small series and lacking randomized large scale phase III trial.